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Information about patients’ occupation is important for prevention, improved diagnosis and treatment of conditions that may be work-related. However, occupation information has not been incorporated systematically into medical records. Electronic health records (EHRs) allow for collection of more patient data, and for display, reporting, and retention of that data over time. Pilot projects are needed to develop best practices for collecting occupation information in clinical settings, coding it, and using it to care for working patients.
METHODS:
A primary care network in Massachusetts worked with the Massachusetts Department of Public Health’s (MDPH) Occupational Health Surveillance Program to pilot collection of occupation information from patients and assess clinical utility of the captured information. MDPH staff trained the healthcare organization’s registration staff to collect occupation information from patients registering over the phone for medical appointments. Brief narrative descriptions were entered into registration software linked to an EPIC EHR system. At the same time, a program for the automated coding of industry and occupation information (NIOCCS) was under development by the National Institute for Occupational Safety and Health (NIOSH). All three partners entered into a project to examine the feasibility of coding the occupation information using NIOCCS and further analyze the data collected.
RESULTS:
In 2010, occupation information was collected for approximately 27,000 patients of the primary care network. More than 10,000 records were coded correctly by NIOCCS; additional records were coded manually. In total, more than 70% of the occupation information was able to be coded to Bureau of Census (BOC) codes. Frequencies were calculated by occupational and demographic groups. Patient occupation and demographic information was used to target patient occupational health educational materials to patients. Project partners gave grand rounds presentations to discuss the project and patient occupational health with healthcare providers.
CONCLUSIONS:
This project demonstrates that occupational information can be collected from patients through telephone registration. Though NIOCCS has been optimized to code industry and occupation information together, a significant proportion of records were able to be coded to BOC codes. Patient occupation information was used to target educational materials and communicate to healthcare providers about work-related risk factors for patient health. This project will inform current efforts to incorporate patient industry, occupation and other work information on electronic health records.